Diarrhea caused by disease or the side effects of the treatment

Dear OncoLink "Ask the Experts,"
What is diarrhea? What can I do to prevent it? When should I call my doctor about it? How is it Treated?

Karen Bruchak, RN, MSN, MBA, OncoLink Editorial Assistant responds:

What is Diarrhea?

Diarrhea refers to the passage of loose or watery stools three or more times a day. Often diarrhea may cause pain or discomfort in the abdomen and/or rectum, but many times it does not. Patients with cancers of the gastrointestinal tract, including the stomach, colon, rectum often experience diarrhea. In addition, diarrhea may be a side effect of the cancer treatment, especially radiation therapy and chemotherapy. Diarrhea caused by cancer treatments may continue for up to 3 weeks after the treatment has been completed or stopped. Other common causes of diarrhea in cancer patients include bacterial and viral infections, anxiety, and supplemental feeding containing large amounts of vitamins, minerals, sugar, and electrolytes. Patients who are constipated may also have leakage of diarrhea.

What Can I Do to Prevent Diarrhea?

Unlike many other side effects of cancer and its treatment, thereare specific actions that you can take to help prevent or minimizediarrhea, including:

Eat small amounts of food 5-6 times throughout the day, instead of three large meals.

Add nutmeg to foods in order to slow down the movement of material through the intestines.

Increase fluid intake. Try to drink about 3 quarts of fluid per day, unless your doctor or nurse tells you not to do so. This will help to prevent dehydration and malnutrition. Specific points to keep in mind include:

Do NOT drink coffee, tea, alcohol, or milk or milk products, since they can make the diarrhea worse.

Drink sports drinks, such as Gatorade, which help to replace certain electrolytes lost in the diarrhea.

Liquids served at room temperature may be less likely to causeadditional diarrhea than cold or hot beverages.

Take measures to promote comfort.

Clean the rectal area well after each bowel movement. Use warm water and soap, and pat dry with a soft towel. This will help to prevent anal burning.

Inspect area daily for red, scaly or broken skin. Report this to your doctor or nurse.

Use sitz baths, or soak in a warm bath.

Ask your Doctor or Nurse about using creams to help withdiscomfort in the anal area. Water repellent creams, such as A &D Ointment are very effective. Your doctor may also order a local anesthetic ointment that can be applied to the rectum.

Use a room deodorizer if odor is a problem.

Take measures to reduce anxiety

Try to stay in a quiet, restful environment.

Whenever possible, stay in an area with close access to abathroom, if needed in a hurry.

Take frequent rest periods and naps throughout the day.

DO NOT smoke cigarettes.

DO NOT use over-the-counter anti-diarrheal medications (Kaopectate,or Immodium AD) If you have tried the measures describedabove and your are still having diarrhea, discuss the situation with your doctor or nurse, who will give your further instructions.

When Should I Call My Doctor?

Call your doctor immediately if you have any one or more of thefollowing:

6 or more loose bowel movements per day for more than 2 days in a row

blood in or around the anal area, in the stool, on the toiletpaper or in the toilet bowel after a bowel movement

no urine for 24 hours

inability to drink liquids for more than 24 hours

fever

weight loss of 5 pounds or more since the diarrhea started

swollen and/or painful abdomen

How is Diarrhea Treated?

Prevention of diarrhea is always the best. If, however, despitespecific actions on your part as described above are not successful, your doctor may order the following:

Over-the-counter anti-diarrheal medications such as Kaopectateor Imodium AD. As ordered by your Doctor

Prescription anti-diarrheal medications such as Lomotil As ordered by your Doctor

IV fluids and/or nutrition to replace the fluid and electrolytesbeing lost in the diarrhea.